by John Fauber John Fauber Reporter, Milwaukee Journal Sentinel/MedPage Today
May 09, 2012

WASHINGTON -- The U.S. Senate Committee on Finance has opened a wide-ranging investigation into questionable financial relationships between companies that make narcotic painkillers and various nonprofit organizations that advocate for the treatment of pain.

Citing MedPage Today/Milwaukee Journal Sentinel investigative reports, the committee is seeking financial and marketing records from three companies that make opioid drugs such as Oxycontin and Vicodin and seven national organizations that advocate for the treatment of pain.

"It is clear that the United States is suffering from an epidemic of accidental deaths and addiction resulting from increased use of powerful narcotic painkillers ... ," according to a joint statement from committee chairman Max Baucus (D-Mont.) and member Chuck Grassley (R-Iowa).

The senators said there was growing evidence that opioid manufacturers may be at least partly responsible for the epidemic by promoting misleading information about the safety and effectiveness of the drugs.

"Recent investigative reporting from the Milwaukee Journal Sentinel/MedPage Today and ProPublica revealed extensive ties between companies that manufacture and market opioids and nonprofit organizations such as the American Pain Foundation, the American Pain Society, the American Academy of Pain Medicine, the Federation of State Medical Boards, the University of Wisconsin Pain and Policy Studies Group and the Joint Commission," Grassley and Baucus wrote.

MedPage Today/Journal Sentinel stories have focused on all of those groups except for the Joint Commission, an organization that accredits hospitals. ProPublica, an online investigative reporting organization, has reported on the American Pain Foundation.

The committee members noted that a February MedPage Today/Journal Sentinel story reported that a "network of national organizations and researchers with financial connections to the makers of narcotic painkillers helped create a body of dubious information" favoring opioids. The information was found in prescribing guidelines, patient literature, position statements, books, and doctor education courses.

The report noted that the network pushed for expanded use of the drugs while taking in millions of dollars from the companies that made them.

Last year, a separate MedPage Today/Journal Sentinel story found that the UW Pain Group had been a national force in helping liberalize the way opioids are prescribed and viewed. While pushing a pharmaceutical industry agenda that critics say was not supported by rigorous science, the organization took in $2.5 million over a decade from opioid companies.

After the story ran in April, the UW Pain group said it had decided to stop taking money from the drug industry.

The organization said its board of directors voted May 3 to dissolve the organization, according to a message on its website. It cited a lack of financial resources and funds needed to remain operational.

It was unknown whether the decision was in any way related to the Senate investigation.

The investigation was applauded by doctors who have been trying to reform prescribing practices.

Andrew Kolodny, president of Physicians for Responsible Opioid Prescribing, said the pain groups, working on behalf of drug companies, helped usher in an epidemic that has killed more than 100,000 people. Kolodny is chairman of psychiatry at Maimonides Medical Center in New York City.

"I think the Senate Finance Committee's investigation will ultimately save lives," said Kolodny, an addiction specialist. "By turning the lights on, it's going to be much harder for these groups to function. And it will be harder for them to pretend they're helping pain patients when it's the drug companies who pay them that they're really helping."

In addition to the pain organizations, the Senate committee also sought records from three leading opioid manufacturers: Purdue Pharma, Johnson & Johnson, and Endo Pharmaceuticals. It also requested records from the Center for Practical Bioethics, a Kansas City, Mo., organization that has advocated for pain treatment.

The committee said it wants records dating back to 1997.

In addition to records of financial transactions between the drug companies and the pain groups, the committee also requested information about any federal funding the groups received.

The committee warned that none of the records it requested should be destroyed, modified, or removed.

James Heins, a spokesman for Purdue Pharma, acknowledged receiving the Baucus/Grassley letter and that the company was "in the process of reviewing it. We look forward to cooperating with the committee on this matter." Johnson & Johnson's Janssen division is reviewing the letter as well and, according to spokesman Jeff Christensen, "will work with them to fulfill their request for information."

Phil Saigh, executive director of the the American Academy of Pain Medicine, said in an email that the group supports the efforts of the U.S. Senate to address the crisis of prescription drug abuse and misuse as well as the crisis of undertreated pain.

Also via email, Humayun Chaudhry, DO, president and CEO of the Federation of State Medical Boards wrote that the organization agrees "with the Committee that the abuse and misuse of opioids is a serious national problem and will provide information requested by the Committee as it addresses the issue. The FSMB remains committed to raising awareness of the problem among physicians and the public and working to reduce the risk of addiction, abuse, and diversion of opioids."

Both the American Pain Society and the UW Pain Group also pledged full cooperation with the Senate investigation.

In an email, the American Pain Society also noted that the organization "looks forward to sharing with the Committee its strong support for a balanced approach to addressing the problem of abuse and diversion of prescription analgesic medications. As advocates for patients and their families, we seek a fair balance between protecting the rights of physicians and patients to have access to a wide range of effective pain medications."

Adding to his statement of cooperation, Robert Golden, Dean of the University of Wisconsin School of Medicine and Public Health noted that "All along, the Wisconsin Pain Policies Study Group has operated under the philosophy that the right to pain medication access should be balanced with responsible medication prescribing."

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